Core belief disruption amid the COVID-19 pandemic in Japanese adults

Since COVID-19 emerged in late 2019 and was declared a pandemic by WHO on March 11, 2020, significant psychological impacts (depression, anxiety, PTSD symptoms, sleep disturbances) have been reported among healthcare workers and the general population. Unpredictability and uncontrollability during pandemics are key drivers of mental health problems. Major societal and lifestyle changes can prompt people to reconsider what is important, discover new aspects of themselves, and gain spirituality—processes referred to as disruption of core beliefs. Core beliefs are fundamental assumptions about human benevolence, fairness of events, and one’s own worth and abilities. When events violate these assumptions, core beliefs can be disrupted, necessitating re-examination. Prior work shows core belief disruption after serious illness, military experience, terrorism, and natural disasters; it predicts post-traumatic growth but is also associated with stressfulness of events and negative mood. In Japan, a state of emergency was declared in April 2020 and lifted in May; although cases and deaths were relatively low, psychological distress was reported. Factors linked to distress include age, gender, financial situation, and marital status, but their association with core belief disruption during a pandemic was unknown. Because lockdowns are not enforceable in Japan, cooperation with preventive measures relies on individual initiative; how the level of cooperation and its burden relate to core belief disruption and psychological distress was unclear. The study aimed to clarify the impact of COVID-19 on core beliefs in the general Japanese population by examining associations among demographics, cooperation with preventive measures and its burden, core belief disruption, and psychological distress.

Design and setting: Cross-sectional online survey of Japanese adults during the COVID-19 pandemic. Participants: 11,035 individuals were invited via Cross Marketing Inc.; 1,200 completed the survey (rewarded with cashable coupons). Four respondents who reported COVID-19 infection in themselves or family were excluded; final N=1,196. Age range 30–79 years. To account for regional differences in COVID-19 prevalence, sampling targeted Tokyo (highest cases per million during Mar 11–May 25, 2020; >190 per million) and Sendai (Miyagi Prefecture; <30 per million). Measures:

• Demographics: age, sex, prefecture (Tokyo or Sendai), marital status (married including divorced/bereaved vs unmarried), school closures of child (experienced vs not), and changes in income due to the pandemic (significantly decreased, decreased, not changed, increased, greatly increased; later recoded to Reduced vs Not reduced).
• Achievement of preventive measures: single item assessing perceived cooperation with measures (e.g., avoiding unnecessary outings) during state of emergency; visual analogue scale (VAS) 0–100.
• Psychological burden of preventive measures: single item assessing perceived burden in cooperating with preventive measures; VAS 0–100.
• Disruption of core beliefs: Japanese version of the Core Beliefs Inventory (CBI; 9 items; 0–5 per item; higher indicates greater disruption/re-examination due to COVID-19). Internal reliability in this study Cronbach’s alpha=0.945.
• Stressfulness of the pandemic: single item “To what extent have you felt stressed about the spread of COVID-19?”; VAS 0–100.
• Psychological distress: Japanese version of the Kessler 6 (K6), assessing distress in the past month; items rated 0–4. Statistical analysis:
• Multiple regression (stepwise, model selection by Akaike Information Criterion) examined predictors of disruption of core beliefs (CBI total score outcome). Candidate predictors: age, sex, prefecture, marital status, school closure of child, reduced income (dummy-coded: Reduced=1 if significantly decreased/decreased; Not reduced=0 for others), achievement of preventive measures, psychological burden of preventive measures, and stressfulness of the pandemic. Variance inflation factors (VIF) assessed multicollinearity.
• Path analysis assessed associations among predictors identified in regression, core belief disruption, and psychological distress (K6). Model fit criteria: CFI>0.95, TLI>0.95, SRMR<0.08, RMSEA<0.06. Significance threshold P<0.05. Analyses performed in RStudio v1.2.5042.

Sample characteristics and descriptives:

• N=1,196; mean age=52.32 (SD=13.78; range 30–79). Male=598 (50%); Tokyo residents=597 (50%); married=853 (71%); experienced school closure of child=167 (14%); reduced income=313 (26%).
• Achievement of preventive measures: mean=77.64 (SD=20.46; 0–100).
• Psychological burden of preventive measures: mean=50.61 (SD=27.83; 0–100).
• Stressfulness of the pandemic: mean=64.14 (SD=25.81; 0–100).
• Core Beliefs Inventory (CBI) total: mean=1.35 (SD=10.23; range 0–45); per-item means generally 1.31–1.55 except item on spiritual/religious beliefs (mean=0.81).
• Psychological distress (K6): mean=5.37 (SD=5.25; 0–24). Multiple regression predicting core belief disruption (CBI total):
• Psychological burden of preventive measures: positive predictor (e.g., Model 4 unstandardized B=0.065, SE=0.012, t=5.322, P<0.001; VIF=1.461).
• Achievement of preventive measures: positive predictor (B=0.046, SE=0.014, t=3.263, P=0.001; VIF=1.060).
• Reduced income due to the pandemic: positive predictor (B=1.650, SE=0.655, t=2.519, P=0.012; VIF=1.020).
• Stressfulness of the pandemic: positive predictor (B=0.027, SE=0.013, t=1.985, P=0.047; VIF=1.526).
• Age, sex, prefecture, marital status, and school closure of child were not significant and were excluded. Final model adjusted R²≈0.072; AIC=5479.30; VIFs <2, indicating no concerning multicollinearity. Path analysis:
• Initial model with only indirect effects via core beliefs did not fit (CFI=0.603, TLI=0.107, SRMR=0.115, RMSEA=0.198).
• Revised model including direct paths to psychological distress fit excellently (CFI=1.00, TLI=1.00, RMSEA<0.001, SRMR<0.001). Standardized path coefficients (all P<0.05 unless noted):
• Burden → core beliefs: β=0.179.
• Achievement → core beliefs: β=0.094.
• Reduced income → core beliefs: β=0.071.
• Stressfulness → core beliefs: β=0.068.
• Core beliefs → psychological distress: β=0.389.
• Burden → psychological distress: β=0.174.
• Reduced income → psychological distress: β=0.160.
• Stressfulness → psychological distress: β=0.200.
• Achievement → psychological distress: β=−0.011 (ns; P=0.684 in model testing). Overall, core belief disruption in the general Japanese population was relatively low, yet higher disruption was associated with greater psychological distress. Burden and achievement of preventive measures, reduced income, and perceived stressfulness predicted greater disruption.

The study shows that while pandemic-related disruption of core beliefs in Japanese adults was relatively low on average, greater disruption was meaningfully associated with higher psychological distress. Disruption was predicted by higher psychological burden and higher self-reported achievement of preventive measures, reduced income, and greater perceived stressfulness of COVID-19. These results address the research question by identifying specific pandemic-related experiences that challenge core beliefs and, in turn, contribute to psychological distress. Cultural and contextual factors may explain the relatively low disruption levels: comparable findings in prior Japanese samples suggest that a general tendency to view life as unpredictable and tragedies as possible for anyone might buffer against large shifts in core beliefs. Unlike contexts with enforced lockdowns, Japan’s reliance on voluntary cooperation may have left threats feeling uncontrollable despite high personal adherence, making cooperation itself a source of core belief disruption. Achievement of preventive measures did not directly increase distress and even trended negatively, possibly reflecting altruistic elements of such behaviors that can enhance positive affect. Reduced income and higher stressfulness predicted both greater core belief disruption and higher distress, consistent with evidence that financial strain undermines self-worth and future expectations and elevates mental health risks. The strong positive link between core belief disruption and distress aligns with models in which challenges to assumptive worlds exacerbate depression and anxiety during collective crises. While core belief disruption can precede post-traumatic growth, the protracted nature of the pandemic underscores the need for mental health supports that acknowledge and address disruptions in fundamental assumptions.

The COVID-19 pandemic disrupted core beliefs among Japanese adults at a relatively low overall level, yet higher disruption was linked to greater psychological distress. Psychological burden and achievement of preventive measures, reduced income, and perceived stressfulness were significant predictors of disruption. Public health strategies should recognize potential psychological consequences of lifestyle changes required for infection control and provide supportive measures to mitigate burden and financial strain. Future research should compare cross-cultural patterns of core belief disruption, examine detailed sources of burden in preventive behaviors, and assess the content and evolution of core beliefs using validated instruments.

• Generalizability: Conducted in a relatively monocultural context (Japan) with comparatively low disease burden and high adherence to preventive measures; cross-cultural comparisons are needed.
• Missing clinical history: No data on participants’ prior psychiatric conditions or treatments, which could influence core belief disruption and distress.
• Measurement granularity: The specific aspects of psychological burden related to preventive measures were not quantified; more detailed assessment could clarify determinants of distress.
• Instrument scope: The CBI measures extent of disruption, not the content or direction of core beliefs; lack of a validated Japanese version of content-focused scales (e.g., World Assumptions Scale) limits interpretability.